First things first. It is very important to become educated about what to expect from any health insurance coverage, and Medicare is no different. Original Medicare is health insurance coverage provided by the Federal government. It is made up of several parts as follows:
- Part A = Hospital Insurance for inpatient and skilled nursing facilities
- As we work and pay taxes, we accumulate “credits” towards Part A. At age 65, this coverage has no premium because we already paid for it through our taxes.
- It covers days 1-60 in the hospital and has a deductible of $1,556 in 2022. Most supplemental coverages cover this deductible. Additional hospital days have a per day charge. These charges are covered by supplemental insurances.
- Skilled Nursing Facility up to 20 days. After that, there is a per day cost. These daily co-insurance costs are covered by supplement insurances.
- Part B = Medical insurance covers 80% of physician services, outpatient care, diagnostic testing and medical supplies and equipment. Part B also covers some medications administered by IV therapy.
- Part B has a monthly premium starting at $170.10 in 2022. This premium could go up to $578.30 for people who earn more than $500K gross income per year.
- For people who have Medicaid due to low income, the State of Florida pays their Part B premium.
- Part D = Covers oral medications
- Part D coverage can be provided either through private insurance companies as standalone Prescription Drug Plans (PDP) or under the umbrella of Medicare Advantage programs (HMO or PPO).
- PDP programs have monthly premiums ranging from $7.30 to $174.30
- Part D also has additional premiums for people who earn more than $114K gross income per year. The Part D premiums can go from $12.40 to $77.90 based on income levels.
- Low income people qualify for Extra Help, which is a Part D federal subsidy which helps pay for drugs.
- Part C = Bundled coverage including Parts A, B, and D through private insurance companies.
- In Dade County, there are a total of 83 Medicare Advantage plans, 66 are HMO and 17 are PPO. All these plans cover the Part A deductible and other charges, as well as cover the Part B 20%, and provide additional benefits not covered by Medicare, like Glasses and transportation.
Getting Medicare means you worked through Social Security to get your Part A and B. After that, you need to decide how to “supplement” that coverage or complete it to make sure you cover the things Medicare does not. There are 2 supplemental coverage options:
OPTION 1
- Medigap – These are private insurance options sold to help fill the “gaps” in Original Medicare. These policies cover co-insurance and deductible for Part A and B only and are sold in options designated by letters: Plans A, B, C, D, G, K, L, M and N.
- Prescription Drug Plans – When you choose a Medigap plan, you need to separately enroll in a Prescription Drug Plan to cover medications. These plans have monthly premiums, deductibles, and co-payments depending on the medication.
OPTION 2
- Part C – Medicare Advantage – HMO and PPO: These are bundled policies covering 100% of Part A and Part B coverage, including medications and additional benefits.
It is very obvious Medicare is complicated and involves many decisions which could affect your health insurance coverage. For this reason, please allow us to help you work through all the options and help you choose the one that is right for you!
